Without a doubt, it is a major error whenever a claims professional stipulates to an injured workers’ Average Weekly Wage (AWW) being “maximum”, even though maximum earnings may exist. The AWW should always be identified as a specific dollar figure instead of taking a shortcut by stating “maximum.” The reason is quite simple. Although the injured …
Investigating Dependency: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
When a fatality claim is filed, the claims administrator’s best practice is to immediately investigate the circumstances of both death and dependency. Often, the only dependent of the decedent is the spouse. For the sake of this blog let us presume that a deceased worker is survived only by a fully dependent wife. The decedent …
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Voucher Eligibility: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
Most claims professionals are aware that LC §4658.7(g) forbids settlement of a Supplemental Job Displacement Benefit (SJDB) voucher for an admitted industrial injury occurring on or after 1/1/2013. There is however, one exception. Namely, when an affirmative defense is raised, where if litigated the employee may “take nothing,” including the voucher. The purpose of today’s …
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WCAB Venue: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
Although it may be difficult to believe, there is a definite home-field advantage in workers’ compensation when it comes to litigating claims at certain Appeals Board district offices. When a judge interacts with a particular attorney every day, there is a natural tendency to favor a familiar face over an attorney who is a stranger, …
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Permanent Disability Stipulations: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
Oftentimes a primary treating physician (PTP) and a qualified medical examiner (QME) disagree over the extent of Permanent Disability. One physician may identify permanent impairment at 40%, while the other rates it at 60%. When PD falls within a range, parties will often split the difference to achieve settlement. In our 40%-60% example, a split …
When Not to Serve a Claim Form: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
We are cautiously optimistic that the title of today’s blog caught your attention in that most claims professionals have been trained that Labor Code §5401 requires an employer to present a DWC-1 claim form to an employee within one business day upon receipt of knowledge from any source of an industrial injury beyond first aid. …
The DWC-5020: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
A DWC Form 5020 is often the first document by which an employer learns about workers’ compensation claim procedures. Created by the state of California, it is also known as the “Employer’s Report of Occupational Injury or Illness,” and is informally known as the “Employer’s First Report” or the “5020.” The DWC-5020 sets forth 39 …
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QME Strike Procedures: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
Do you know what happens in a workers’ compensation case when an applicant and their employer simultaneously strike the same physician from a PQME list? Do you know what happens when a party fails make any strike? The answers to these questions are not contained in either the Labor Code or the Code of Regulations, …
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Defending Conditional Payment Claims: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
It is safe to presume that every administrator of claims for workers’ compensation benefits is aware of the government’s right to seek reimbursement of Medicare Conditional Payments. These payments are known as Medicare Secondary Payer (MSP) claims and are asserted by Medicare Secondary Payer Recovery Contractors (MSPRC) who seek reimbursement in the federal government’s behalf. …
A Near Miss: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
As strange as it may seem, employers in workers’ compensation can learn a valuable lesson from the airline industry. At 11:56 p.m. on the evening of July 7, 2017, the largest aviation disaster in the history of the world was narrowly averted by less than 1 second. It occurred at San Francisco International Airport when …
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Defending Your MPN! A Sixty-Second Seminar in Workers’ Compensation Claims Handling
It’s no secret that injured workers and applicant attorneys dislike Medical Provider Networks (MPN). They exploit every loophole to escape an MPN to select a doctor of their choice to be the worker’s primary treating physician (PTP). For years, a popular method to escape an MPN was for the worker to request a physician in …
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The Company Picnic: A Sixty-Second Seminar in Workers’ Compensation Claims Handling
During the warm summer months many businesses elect to close for an afternoon to hold a good old-fashioned company picnic. Everyone goes off to a local park for a delicious barbeque lunch where employee camaraderie abounds, fostered by games, contests, and other physical activities, competitive and goofy. Typically, everyone has a great time, but very …
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